BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.212 of 2016
Date of Instt. 12.05.2016
Date of Decision: 11.12.2018
Ravi Kumar son of Late Shri Roop Lal, Resident of House No.15, Indra Colony, Village Dhina, Jalandhar Cantt.
..........Complainant
Versus
Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, Model Town Road, Jalandhar through its Senior Divisional Manager.
….….. Opposite Party
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Harvimal Dogra (Member)
Present: Sh. H. S. Sandhu, Adv Counsel for the Complainant.
Sh. M. S. Sachdev, Adv Counsel for the OP.
Order
Karnail Singh (President)
1. This complaint has been filed by the complainant, wherein alleged that Smt. Swarani Widow of Late Shri Roop Lal (since deceased) mother of the complainant had been got life insured policy bearing No.133870545 for sum assured Rs.2,00,000/- with OP under Plan No.814 for terms 15 years. The proposal date 30th May, 2014 was accepted at ordinary rate of premium as Standard Life. The risk of the policy commenced from 02.06.2014. The mode of payment of installment of premium was quarterly of Rs.3867/-. The proposal form was filled in English language on 26.05.2014. The thumb impression was taken on the printed column. The life assured was medically examined by the appointed medical officer Dr. Mrs. Dimple Malhotra. The life assured was illiterate and could not sign, read and not conversant with English language. The source of the income of the life assured was Family Pension after the death of her husband from BSF on 05.12.2013. The OP obtained reports on the requisite forms from securing agent, Development Officer and Moral Hazard Report etc. on the eve of proposing for insurance and carefully and thoroughly scrutinized and verified before acceptance of proposal. All of them in their respective reports recommended her life for insurance as would be clear from their reports with OP pertaining to policy subject matter of the complaint.
2. That the life assured on 07.12.2014 had complained of pain in stool passage and was taken for treatment in Civil Hospital, Jalandhar, but unfortunately, expired on the same day i.e. 07.12.2014. The cause of death was cancer diagnosed on admission on 07.12.2014 in Civil Hospital, Jalandhar. That subsequent to the death of life assured, the complainant lodged death claim with OP through its policy servicing branch office for payment of Sum Assured with accrued Bonus and other benefits, but the claim of the complainant was repudiated, vide letter No.142/33 dated 26.05.2015 on the ground that the insured withheld the correct information from OP regarding her marital status, occupation and age at the time of getting insurance policy, whereas the life assured had not violated any terms and conditions nor concealed any facts and further submitted that the OP has not followed the mandate of IRDA Regulations 2002, which obligate upon OP vide its clause 4.1 and 6.2 to furnish to the insured free of charges within 30 days of acceptance of the proposal. A copy of proposal form and shall inform by the letter forwarding the policy that he had a period of 15 days from the date of receipt of the policy documents to review the terms and conditions of the policy and where the insured disagreed to any of those terms and conditions, he has the option to return the policy stating the reasons for his objection. OP consciously violated mandatory IRDA Regulations in as much as a copy of proposal form free of charge required to be given to the insured was not supplied and as such, the OP is guilty of deficiency in rendering services, negligent and indulged in unfair trade practice, which gave a cause of action to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay sum assured Rs.2,00,000/- along with Bonus vested attached and accrued in policy covered and further OP be directed to pay interest @ 12% per annum on the sum assured and bonus from the date of death of the life assured upto date of actual payment and further OP be directed to pay compensation of Rs.50,000/- for causing harassment, mental tension and agony and litigation expenses of Rs.10,000/-.
3. Notice of the complaint was given to the OP, who filed reply and contested the complaint by taking preliminary objections that no cause of action has accrued to the complainant to file the present complaint and as such, the same is liable to be dismissed with special and compensatory costs and further submitted that the complainant has got no locus-standi to file the present complaint and the same is liable to be dismissed with special and compensatory costs and further averred that the present complaint is not maintainable before this Forum as intricate question of law and evidence is involved in the present case, so on this score also, the same is liable to be dismissed and even the present complaint is barred by limitation, so on this score also, the same is liable to be dismissed and further submitted that the complainant Smt. Swarani had got herself insured vide Policy No.133870545, which was commenced from 14.06.2014 and the date of proposal was 26.05.2014. The date of F.P.R. was 14.06.2014 and the sum assured was Rs.2,00,000/- and the mode of payment was quarterly. The installment premium was Rs.3867/-. The age at entry was 52 years and she had also got registered her son Ravi Kumar, as her nominee. The date of death of Smt. Swarani is 07.12.2014 and the date of repudiation was 26.12.2015. The form was duly filled at the instance of Smt. Swarani, who after admitting the contents of the same as correct, thumb marked the same. It is to be mentioned herein that in the medical report, which is signed by the doctor in the presence of Life Assured, who also affixed her thumb impression. It was clearly mentioned in the proposal form at Column No.14(b) that the contents of the said form and the documents have been fully explained to Smt. Swarani by Shri V. M. Khanna, agent. The policy was started as per rules and as per the law and further the claim was repudiated by the Competent Authority due to the reason that the material facts were suppressed regarding the age and the marital status of Smt. Swarani and thereafter, the claim was rightly repudiated and further alleged that there is no deficiency in service nor there is any ground for allowing this complaint, therefore, this complaint is liable to be dismissed. On merits, it is admitted that Smt. Swarani Devi has got herself insured with the OP and she died and her claim was submitted, but the same was rightly repudiated. The other averments as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
4. In order to prove the case of the complainant, the complainant himself tendered into evidence his own affidavit Ex.CA alongwith some documents Ex.C-1 Copy of LIC Form, Ex.C-2 Agent Confidential Report, Ex.C-3 Medical Examiner Confidential Report, Ex.C-4 Policy Report, Ex.C-5 Copy of Aadhar Card, Ex.C-6 Bank Statement of Swarani Devi, Ex.C-7 Claimant Statement, Ex.C-8 Certificate of Identity and Burial or Cremation, Ex.C-9 Medical Attendant's Certificate, Ex.C-10 Certificate of LIC of Hospital Treatment and then closed the evidence.
5. In order to rebut the evidence of the complainant, counsel for the OP tendered into evidence affidavit of Sh. Jagdish Sharma, Manager as Ex.OPA-1 and affidavit of Sh. Gurdeep Lal, Branch Manager as Ex.OPA-2 along with some documents Ex.OP-1 Circular, Ex.OP-2 Claim Enquiry Report, Ex.OP-3 Authorization Letter, Ex.OP-4 Proposal Form, Ex.OP-5 Pension Order, Ex.OP-6 Repudiation of Claim Letter dated 26.12.2015, Ex.OP-7 Status and History of the Case and Ex.OP-8 Copy of Policy Bond and then closed the evidence.
6. We have heard the argument of learned counsel for the respective parties and also gone through the file very minutely.
7. We have found that the facts of the complaint in regard to purchase of policy by insured Swarani Widow of Late Shri Roop Lal and after her death the claim was lodged by the complainant and the same was repudiated, are not in dispute.
8. The dispute arises upon the repudiation of the insurance claim by the OP, vide repudiation letter dated 26.05.2015, which is available on the file Ex.OP-6, the ground took in the aforesaid repudiation letter are that the insured made deliberate mis-statement and withheld the correct information from OP regarding her marital status, occupation and age at the time of inception of the insurance policy and due to these concealment, the claim of the complainant has been repudiated.
9. In the first para of the repudiation letter, it is described that:-
“Smt. Swarani Devi obtained the insurance policy by mentioning in the proposal form that her husband alive and her occupation as self employed and her date of birth is 15.03.1962, whereas as per family pension order Ex.OP-5, the age of the insured has been shown 45 years and considering above it is clear that the husband of the insured expired well before the date of proposal and insured was having pension income only and her age as on date of proposal was more than 55 years.”
and further described in the repudiation letter as under:-
“Consequently, being illiterate widow above 50 years age, she was not eligible for insurance cover at all. But, she managed to obtain the above policy by making deliberate mis-statement in the proposal form about her Marital Status, Occupation and by understanding her age at least by 3 years while proposing for the insurance. Had she given correct information regarding her marital status, occupation and age in the proposal form at the time of insurance, she would not have been granted the said insurance as per rules.”
10. If, we consider the above language of the repudiation letter Ex.OP-6, then we can say without any hesitation that the Proposal Form Ex.OP-4 produced on the file by the OP itself shows that the age described by the insured, therein is 52 years and date of birth is 15.03.1962. Similarly, if we go through the authenticated document Ex.C-5 Aadhar Card, wherein date of birth of the deceased insured Swarani Devi is mentioned the birth year 1962 and similarly, the age described by the deceased Swarani Devi 52 years in the form filled by the Insurance Company at the time of medical examination, the same is Ex.C-3. If we co-relate the above date of birth as well as 52 years with the pension order Ex.OP-5, then we can say without any hesitation that the age mentioned in the pension order as 45 years is not authenticated one because the said age might be recorded inadvertently by the official of the employer of the husband of the deceased insured, but the date of birth and age disclosed by the insured deceased Swarani Devi, to the official of the OP is authenticated one, which is 52 years and if the age disclosed by the insured 52 years at the time of inception of the policy, then it is to be seen by the official of the OP whether the person having age above 52 years is eligible for insurance or not and if the official of the OP did not care for it, then it is fault as well as negligence on the part of the OP not of the insured and further the occupation of the insured has been mentioned as self employed in the Insurance Form Ex.OP-4 and this statement of the insured is not rebutted by the OP by bringing on the file any other cogent and convincing evidence that she is employee in any department, if so, then we find that the plea taken by the OP is not sustainable in the eyes of law and further in regard to marital status of the insured is not in dispute because the insured never disclosed herself spouse living and if the word in the Insurance Form Ex.OP-4, has been written wife of instead of widow, then it is the fault on the part of the official of the OP because the account statement of the bank of the insured itself shows that she is a widow and premium of the insurance policy was withdrawn by the OP from the said bank and photostat copy of the same is available on the file Ex.C-6.
11. From the above detailed discussion, it is clearly established that there is a negligence as well as deficiency in service on the part of the OP, therefore, we hold that the complainant is entitled for the relief claimed and accordingly, the complaint of the complainant is partly accepted and OP is directed to pay the sum assured of Rs.2,00,000/- along with bonus, if any to the complainant along with interest @ 12% per annum from the date of repudiation of the letter i.e. 26.05.2015, till realization and further OP is directed to pay compensation to the complainant for mental and physical harassment, to the tune of Rs.25,000/- and litigation expenses of Rs.10,000/-. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Harvimal Dogra Karnail Singh
11.12.2018 Member President
